Lecture 8: Upper Cervical Spine and Headaches Flashcards
What are some important subjective questions to ask someone about HA during an eval?
onset, duration, area of pain, frequency, quality of pain, aggravating factors, relieving factors, meds, PMH, family history
What is prominent motion at AO joint?
the nod, flexion and extension
What is prominent motion at AA joint?
rotation
What is important to remember about nerves c1-c3?
joint dysfunction at upper cervical spine can cause nerve root irritation and referred pain to head and neck
Where does nerve root c1 exit?
posterior arch broad groove for the VA artery and sub occipital nerve
Where does nerve root c2 exit?
behind superior articular process
Where does nerve root c3 exit?
anterior to inferior articular process
What will pain feel like to patient if it is coming from the joint receptors?
dull and achy
What will pain feel like to patient if it is coming from the nerve itself?
sharp, superficial
What grey matter nucleus is primarily responsible for HA?
Trigeminocervical nucleus- nociceptive of the head, throat and upper neck
all afferents from CN 5,7,9,10 and c1-3 nerves converge to this nucleus
Why does referred pain occur with a HA?
if neuron receives afferent input from 2 different cervical receptive fields stimulation of one the receptive fields may produce pain in the other
EX: c1 or c2 can be so irritated it cause nausea
What are the three major categories of HA and which can PT treat?
- migraine
- tension
- cervicogenic
What are red flags associated with HA?
persistent unrelenting HA, associated trauma, supine position increases HA (ICP), visual changes, CNS sx, fever, weight loss, onset with exertion (ICP), temporal arteritis
What must be tested with every pt who presents with HA?
CN testing
What is the major cause of onset for migraines?
hormonal changes/stimulation (puberty, pregnancy)
lasting 4-72 hours
What is the frequency pattern of migraines?
cyclical
What are of the head is usually associated with migraines?
unilateral frontal lobe above eyes
What is the quality of pain associated with migraines?
mod-severe and pulsating which is different than most types of HA
What type of aggravating factors are associated with migraines?
movement- stress, strong sense like smell or loud music
What can usually help to relieve migraines?
neurotryptan with ibuprofen or indomethacin
How is family history and migraines related?
runs in families especially in females
What are common characteristics of tension HA?
insidious onset lasting 30 min to 7 days in a band like pattern around the head
usually mild to mod pain no debilitating caused by stress or tension
What can help with tension HA?
stress reduction, exercise, NSAIDS
What are characteristics of cervicogenic HA?
likely caused by micro or macro trauma to neck such as poor prolonged posture or WAD/concussions
can last a few hours or several days which starts as dull ache but then becomes throbbing
What area of pain is common associated with CG HA?
unilateral- suboccipital or neck
What is common cause of CG HA?
movement postures or the position of the head on the neck
usually female dominant
What other sx can CG HA present with?
Nausea, blurred vision, sharp dermatomal pain
What are three diagnostic areas to consider with potential CG HA?
- cervical spine involvement
- head pain characteristics
- various attack related phenomena
What are cervical spine involvement diagnostic criteria for CG HA?
reproduced by C- ROM., restrictions in ROM, ipsilateral neck and shoulder pain
What are three medical screening tests that need to be done for an Upper c spine eval?
- VA
- ligament stability
- CN assessment
How can you bias the lower cervical spine for ROM assessment?
pre flex upper with a chin tuck
How can you bias the upper cervical spine for ROM assessment?
flex lower cervical with flexion rotation test
What is the flexion rotation test?
pt in supine and PT performs passive full cervical flexion and then rotates pt head
positive if ROM is decreased by 10 degrees (norm is 44)
What should PT look for on palpation during UCS eval?
tension or guarding of superficial muscles, first rib elevation (overactive scalenes)
What is purpose of Neural Tension Provocation Test for UCS?
tests for reason of restriction in suboccipital muscles, is muscle tight or is tightness due to sensitive nerve which leads to ms guarding
most pts with HA will have muscle guarding
What are additional components of an UCS eval?
muscle length and muscle control exam (CCFT)
Why are the DNF so important?
these are postural stabilizers and must stiffen before movement to keep spine as one
What is wry neck deformity?
common term given to most UCS dysfunction, joint is blocked
What are 4 types of wry neck deformities that PT can treat?
- traumatic
- sudden onset
- muscular
- Post Viral
What are 3 types of wry neck deformities we don’t treat?
- Acquired
- spasmodic torticollis- neurological condition
- hysterical- psychological
What is the most common type of wry neck deformity?
traumatic- common in young hypermobile females associated with microtraumas and motor control deficits
What is sudden onset wry neck deformity?
facet or jt dysfunction , self resolves 1-2 weeks
What is you suspect a disc injury with sudden onset wry neck deformity?
no manipulation and soft collar for 2-3 days
What is muscular wry neck deformity?
likely in infants, spasm in SCM causes lateral flexion and CL rotation
usually treated with STM resolves 1-2 weeks
What is post viral wry neck deformity?
spontaneous onset in child or adolescent after a URI causing temporary insufficiency of UCS ligaments
What is important to ask if you suspect post viral wry neck deformity?
ask if they’ve been sick lately, was it a URI?
What is tx post viral wry neck deformity?
NO manual therapy, light ROM, stretching of non neck muscles, exercise, STM
